Stop-Loss Claims Auditor: Detail‑Oriented Analyst

001 Brown & Brown, Inc; United States; Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Health benefits

401k

Tuition reimbursement

Paid time off

Job summary

Brown & Brown is seeking a Specific Stop Loss Claims Auditor to join our growing team. The incumbent will provide Specific Stop Loss claims auditing services for MGU and/or Carrier clients and collaborate with TPAs.

The role requires Excel proficiency, 2+ years of claims experience (stop loss, HMO reinsurance, or provider excess), and strong analytical and communication skills. Pay range is substantial with comprehensive benefits.

Qualifications

• Must have Excel proficiency including basic formulas, sorting, and Pivot Tables.
• Minimum 2 years claims experience with first-dollar medical, specific/aggregate stop loss, HMO reinsurance, or provider excess claims.
• Experience with industry repricing methodologies (PPO, Wrap Networks, Reference Based Pricing, etc.).
• Demonstrated proficiency in Microsoft Office including Outlook.
• Strong analytical/critical thinking and detail orientation; excellent written and verbal communication.
• Ability to work independently with minimal supervision.

Responsibilities

• Analyze Specific Stop Loss claims.
• Identify and isolate data for specific claim submissions.
• Validate expenses under the stop loss policy and SPDs.
• Accurately apply deductibles and coinsurance; manage lasers.
• Provide customer service for MGU partners and TPAs.
• Follow up on all pended claims promptly.
• Contribute to process improvements and new workflows.

Skills

Excel Proficiency

Claims experience

HMO reinsurance

PPO pricing

Microsoft Office

Analytical skills

Communication skills

Independent work

Managed care audit

Tools

Pivot Tables

Microsoft Outlook

Job description

Brown & Brown is seeking a Specific Stop Loss Claims Auditor to join our growing team. The incumbent will provide Specific Stop Loss claims auditing services for MGU and/or Carrier clients and collaborate with TPAs.

The role requires Excel proficiency, 2+ years of claims experience (stop loss, HMO reinsurance, or provider excess), and strong analytical and communication skills. Pay range is substantial with comprehensive benefits.